Spurred on by financial incentives from Medicare, critical access hospitals (CAHs) have significantly increased the number of elective surgeries they perform, The Wall Street Journalreported. But the 30-day mortality rate for major, commonly performed orthopedic surgeries including joint replacement was 34 percent higher for CAHs than for other hospitals, a newspaper analysis found.

After adjusting for varying patient health conditions, ages and other factors, the 30-day mortality rate for inpatient joint replacements was about 9 per 1,000 at CAHs in 2013, compared with about 5 per 1,000 at general hospitals, the WSJ reported.

The number of inpatient joint-replacement surgeries covered by Medicare in 2013 soared by 42.6 percent at critical access hospitals compared with 2008, according to the article--"far outpacing the growth of those services at general hospitals."

CAHs typically are paid more than general hospitals for the same Medicare-reimbursed services, the newspaper reported. The hospitals also are exempt from having to report quality measures such as surgical complication rates, according to the article.

Last year, the Office of Inspector General of the U.S. Department of Health and Human Services found Medicare patients treated at critical access facilities are charged up to six times more for outpatient care than patients at other hospitals, FierceHealthFinance previously reported.

For their part, critical access hospital administrators are urging Congress to pass the Protecting Access to Rural Therapy Services Act, which provides more flexibility regarding doctor supervision of minor outpatient therapies. They were successful in getting passed the Critical Access Hospital Relief Act, which frees doctors from having to certify that a Medicare beneficiary can expect to be discharged or transferred to another hospital within 96 hours. They have warned more rural hospitals are at risk of closing unless they receive regulatory relief, as FierceHealthcare reported.